Texas has sued a Dallas doctor over accusations of providing gender-affirming care to youths, marking one of the first times a state has sought to enforce recent bans driven by Republicans.

The lawsuit announced by Republican Texas Attorney General Ken Paxton on Thursday alleges that Dr. May Lau, a physician in the Dallas area, provided hormones to over 20 minors in violation of a Texas ban that took effect last year.

It is the first time Texas has tried to enforce the law, said Harper Seldin, a staff attorney for the ACLU’s LGBTQ & HIV Project. He also said he was not aware of other states that have tried to enforce similar bans.

“Today, enforcement begins against those who have violated the law,” Paxton’s office said in the lawsuit, which was filed in suburban Collin County.

The Texas law prevents transgender people under 18 from accessing hormone therapies, puberty blockers and transition surgeries, though surgical procedures are rarely performed on children.

Seldin said that while he couldn’t comment on the facts of this case, he said the lawsuit is the “predictable and terrifying result” of the law, which his organization tried to prevent by challenging it.

“Doctors should not have to fear being targeted by the government when using their best medical judgment and politicians like Ken Paxton should not be putting themselves between families and their doctors,” Seldin said.

Lau is an associate professor in the pediatrics department at UT Southwestern Medical Center in Dallas, according to the UT Southwestern website. The lawsuit said she has hospital privileges at two area Children’s Health hospitals.

The lawsuit accuses her of “falsifying medical records, prescriptions, and billing records to represent that her testosterone prescriptions are for something other than transitioning a child’s biological sex or affirming a child’s belief that their gender identity is inconsistent with their biological sex.”

Paxton is asking the court for an injunction against Lau and for her to be fined as much as $10,000 per violation.

Lau nor UT Southwestern immediately replied to requests for comment on Thursday.

Children’s Health said in a statement that it “follows and adheres to all state health care laws.”

At least 26 states have adopted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. Federal judges have struck down the bans in Arkansas and Florida as unconstitutional, though a federal appeals court has stayed the Florida ruling. A judge’s orders are in place to temporarily block enforcement of the ban in Montana. New Hampshire restrictions are to take effect in January.

The lawsuit comes just weeks before an election in which Republicans have used support of gender-affirming health care as a way to attack their opponents. Republican Sen. Ted Cruz has repeatedly blasted his Democratic challenger, US Rep. Colin Allred, for his support of transgender rights.

The Texas ban was signed into law by Republican Gov. Greg Abbott, who was the first governor to order the investigation of families of transgender minors who receive gender-affirming care.